Still waiting for courses to be reviewed for Sanction 2

My compliance officer tells me she has not had time to review my 344 CEUs to see if they are sufficient (yes they are). She claims she has to review them with the new Director of Investigations and to follow up on Tuesday 10/23. I do not hear from her on Tuesday, nor do I hear from the new Director, Dr. Cresswell. I decide to write him on 10/29/2018. All this stalling is not only aggravating me but preventing me from making a living. My cancer is still here, but I cannot afford or qualify for medical coverage in order to follow up on it. So, I wait.

10/19/2018 JM, I have been out of the office and have not had time to review your courses with the new Director of Investigations.  You can follow-up with me on Tuesday [10/23/2018] to see if they were approve.  From a cursory review, what you submitted appears to be adequate. Thanks, ES

10/21/2018 Ms. Spooner 
I didn’t realize you were away from the office. Usually I receive an auto reply stating ones absence in that circumstance. 
Regardless please pass along the name of the new director and contact info. Thank you. JM 

10/22/2018 Ms. Spooner, 
I am unsure of who to call regarding making a complaint against the LSBME as seen in the fine print of your email. Can you please direct me to a person? Is Mr. Cresswell the person I need to be in touch with? Thanks so much,
JM

10/22/2018 My compliance officer responded with Dr. Cresswell’s information.

10/22/2018 ES, Thank you. JM

10/29/2018 Hi Dr. Cresswell, 
I was under the assumption that Ms. Spooner would be discussing these courses with you, but in typical fashion, I have not received a reply from her regarding these. I look forward to hearing that I have fulfilled the courses requirement sanction. 
Thank you. JM

Third email. Pls respond ASAP. Sanction 2

10/19/2018 Hi Ms. Spooner.
This is the third time I’m sending this email. Is there a reason you are not communicating with me? 

I just wanted confirmation that these Board of Nurses courses (from RN.com) I’ve taken from the are sufficient. Im including a list of all the courses over the last four years. You’ll see that I have over 344 CEUs of which 61.95 CEUs (23 classes) are in Medical Record Keeping, 32 CEUs (13 classes) are in Medical Ethics and 53.9 CEUs (17 classes) are in the evaluation and identification of high risk pregnancies. I’m sure you’ll find these as more than sufficient in fulfilling this sanction 2.   
Thank you. JM

Esparonzia Spooner <espooner@lsbme.la.gov>Oct 19, 2018, 6:26 PM
to me

Ms. Macaluso,

I have been out of the office and have not had time to review your courses with the new Director of Investigations.  You can follow-up with me on Tuesday to see if they were approve.  From a cursory review, what you submitted appears to be adequate.

Thanks,

Esparonzia “Ronnie” Spooner, MBA

Program Compliance Officer

Louisiana State Board of Medical Examiners

630 Camp Street

New Orleans, LA 70130

Office (504) 568-1091  Fax (504) 568-5754

www.lsbme.la.gov

*CONFIDENTIAL*

This email transmission, including any attachments, is intended only for the named recipient(s) and may contain information that is privileged, confidential and/or exempt from disclosure under applicable law.  If you have received this transmission in error, or are not the named recipient(s), permanently delete this transmission, including any attachments.

In compliance with Act 2018-655, the Board gives notice to its licensees and applicants of their opportunity to file a complaint about board actions and board procedures. You may submit such complaints to one or more of the following organizations:

1. Louisiana State Board of Medical Examiners; 630 Camp Street, New Orleans, LA 70130; (504) 568-6820; lsbme@lsbme.la.gov.

2. Committee on House & Governmental Affairs; La. House of Representatives; PO Box 44486, Baton Rouge, LA 70804; (225) 342-2403; h&ga@legis.la.gov

3. Committee on Senate & Governmental Affairs; La Senate;PO Box 94183, Baton Rouge, LA 70804; (225) 342-9845; s&g@legis.la.gov.

From: Jackie Mac <jmacmidwife@gmail.com
Sent: Friday, October 19, 2018 4:28 PM
To: Esparonzia Spooner <espooner@lsbme.la.gov>
Subject: Third email. Pls respond ASAP. Sanction 2 Jacqueline Macaluso

Jacqueline Macaluso <jmacmidwife@gmail.com>Oct 21, 2018, 2:26 PM
to Esparonzia

Ms. Spooner 
I didn’t realize you were away from the office. Usually I receive an auto reply stating ones absence in that circumstance. 
Regardless please pass along the name of the new director and contact info. Thank you. 
Jacqueline Macaluso 

Second email. Please respond ASAP

I am getting really tired of having to constantly email these people and get no response. How is any of this legal? They take my license and prevent me from fixing the licensing then do not respond to my emails in regards to fixing it. Its outrageous! The LSBME’s attitude that is above the law is not fair or just. This is my second email to my Compliance officer, Ms. Spooner. Same message as it was 6 days earlier.

Hi Ms. Spooner.
I just wanted confirmation that these Board of Nurses courses (from RN.com) I’ve taken from the are sufficient. Im including a list of all the courses over the last four years. You’ll see that I have over 344 CEUs of which 61.95 CEUs (23 classes) are in Medical Record Keeping, 32 CEUs (13 classes) are in Medical Ethics and 53.9 CEUs (17 classes) are in the evaluation and identification of high risk pregnancies. I’m sure you’ll find these as more than sufficient in fulfilling this sanction 2.   
Thank you.  JM

Applying for Medicaid

I never thought I would have arrived at the place where I cannot afford medical care, but here I am. Because I have not had medical care since last January, and it does not look like I will have a license anytime soon, I apply for Medicaid. The county I live in has a federally-funded program that provides medical care to people who fall through the cracks–the ones who don’t fit the criteria of someone who lives in a state who didn’t expand medicaid. I apply online, but my life insurance, which I keep because I have cancer, creates a flag and the medicaid office wants me to make a personal appearance in a local office. I didn’t realize this personal appearance had to be made in a timely manner and have since received a letter disqualifying me from straight medicaid, which I knew would happen. I just want to keep tabs on my thyroid cancer. Hopefully either I will get licensed soon or health insurance.

First email re:sanction 2 (344 CEUs)

So I practically have another college degree based on the number of continuing education units I have taken in the last three years. For reference in order to recertify a midwifery license in Louisiana, one needs 15 CEUs/per year. I have 344. Not only do I have a EMT certificate, BS degree, AA degree in midwifery, and Diploma in Midwifery, I have the NARM’s most recent certification— the bridge certificate to essentially make my education standard. I am a preceptor able to teach fledgling midwifery students. I am basically over-qualified for any out-of-hospital midwife position. States should be clamoring to have me practice there. They should be handing me licenses. Since my compliance officer still (since 2017) has not answered my question about which classes will fulfill sanction 2, I reach out to her once again.

Hi Ms. Spooner.
I just wanted confirmation that these Board of Nurses courses (from 
RN.com) I’ve taken from the are sufficient. I’m including a list of all the courses over the last four years. You’ll see that I have over 344 CEUs of which 61.95 CEUs (23 classes) are in Medical Record Keeping, 32 CEUs (13 classes) are in Medical Ethics and 53.9 CEUs (17 classes) are in the evaluation and identification of high risk pregnancies. I’m sure you’ll find these as more than sufficient in fulfilling this sanction 2.   
Thank you.  JM

Appealing the Florida denial

Because applying for licensure shouldn’t be easy right? I mean what value exactly does the Constitution hold if I cannot pursue employment in my field, or any field for that matter, despite never having had anything happen. Its absurd. So, in timely fashion I lawyer up because you know that is where I am at with life. I am blessed to be able to have the ability to pay on credit for decent lawyers in my life (except for my divorce one, but that was because she was literally the only one who would take me, but I digress.) So, I found one, that was honestly perplexed by the Department of Health’s actions. Like I stated previously, the DOH usually allows the applicant the ability to withdrawal an application without harm to his/her record. They are not letting me do this, interestingly. So, my attorney states that he will begin the appeal process under the guise of hoping to make a deal with them for both of us to avoid having to go to a hearing in lieu of having my license withdrawn. Whatever. At this point I am so fed up with midwifery and licensure. In the meantime, I reopen my ongoing battle with my incompetent compliance officer in Louisiana in order to try and get off suspension there before my appeal date in Florida. Tell me why I did not go into dentistry again?

My documents submitted to Florida….

Reaching out to the media and legislators

After speaking with a dozen or so attorneys, the take home message is that I most likely have to get my license off suspension in Louisiana before I can succeed in Florida. What a conspiracy. The Federation of state medical boards is the biggest cartel in healthcare, next to the insurance companies of course. What happened to my Constitutional rights to life, liberty, and the pursuit of happiness? I literally cannot get a job because this bogus suspension shows up in a background check. I am a midwife. I wish I had skills to landscape yards or fix cars, but I don’t. It is hard enough finding a job with such a specific skill set, let alone when your background check comes back with this. I begin searching Google for answers. What options do I have? Obtaining an attorney to apply the denial in Florida will be expensive and long and possibly result in no license. Likewise, pursuit of litigation in Louisiana could result in nothing as well except more debt. The medical board isn’t the only thing corrupt in Louisiana– the court system is as well.

I reached out to several news agencies and bloggers. I shared my piktograph on social media. I was on the hunt to find others who could help me dig out of this never-ending hole. After finding Dr. Orient’s article on how LSBME is above the law, I contacted the Senator from her story– John Milkovich. It was suggested to me by a few attorneys to reach out to a few legislators and see if they could put political pressure on the board. Senator Milkovich seemed like the perfect candidate as not only did he propose the bill to provide oversight for the LSBME, but his fervent presentation in front of the Louisiana legislature was nothing short of fire and brimstone Senate style. It was amazing to see someone else so passionate about justice for his constituents. So, I emailed him.

Hi Senator,
First off I want to thank you for presenting the LSBME bill. My midwifery license was also unlawfully suspended indefinitely unless I enter a drug rehab facility for a physical and mental health evaluation (to which no drugs nor alcohol nor mental health issues were in my case at all). It is ridiculous that these people can continue to ruin lives as they do. If you have any contacts to how I can put pressure on the LSBME to work with me, please let me know. I have $18,000 in fees to pay, the $5,000 week long physical and mental eval to attend, three courses, a test to take regarding rules and regulations, and the $300 fine. But they keep moving the ball so-to-speak, telling me my courses arent good enough– they have to be preapproved, and that I cant complete the test sanction until I have the mental health evaluation. Any advice on getting part of my life back is appreciated. Thank you. 
JM

Withdrawing the Florida midwifery application

Florida conveniently has a rule where they tell you up front that you are going to get denied a license. According to one of the dozen attorneys I spoke with in Florida, about 90% of the time once your license enters this denial period, you can request that the Department of Health withdraws it from consideration so that it does not go on your permanent record and make it harder if not impossible to get licensed anywhere else. Of course, with my luck, I would be the 10%. The council of midwifery and the Department of health not only ignored my phone calls and emails the week preceding my deadline (you have three weeks after you receive the notice of intent to deny to file an appeal or withdrawal request) but then denied my request at the last minute to withdrawal my application. I ended up calling many people in the Department and getting nowhere. Thankfully my attorney, yes another one, got my request for an appeal in at the last minute. We are currently awaiting the appeal process. Below is a summary of the email I was waiting on from Gerry the Regulatory Supervisor.

9/17/2018 Hi Gerry.  I’d like to formally withdrawal my application from consideration. Thank you for your time. JM


9/21/2018 Hi Gerry, Due to a deadline quickly approaching I need answer today regarding the possibility of withdrawing my application.   I’ve sent a couple emails to you this week and I just called you. This lack of communicating with me is interfering with my ability to make a decision regarding my case. Please get back with me today regarding this request. Thank you. JM

9/24/2018 JM, I have been working on a response to your concerns; this required confirming that you have received the Notice of Intent to Deny filed regarding your application. As we have confirmed successful delivery of the Notice, an accurate response may now be provided. Please see the attached letter. Regards -Gerry Nielsen
Regulatory Supervisor
(850) 617-1962
Gerry.Nielsen@flhealth.gov


September 24, 2018
Jacqueline Anne Macaluso

IN RE: Application for Midwifery License (File 371)
Dear Ms. Macaluso:
Thank you for your inquiry concerning the status of your application for licensure as a midwife. Your
application was reviewed by Council staff, and it was determined that your application should be denied
due to previous disciplinary history.
At this time, you may not withdraw the application, as it has been denied. A Notice of Intent to Deny,
which states with specificity the reason for denial and explains your appeal rights pursuant to 120.57,
Florida Statutes, was filed with the Agency Clerk on August 31, 2018. This Notice was sent via certified
mail to your address of record at:

Confirmation of delivery to this address on September 5th was provided by the United States Postal
Service.
A copy of the Notice of Intent to Deny has been attached for your convenience.
Sincerely,
Gerry Nielsen
Regulatory Supervisor / Consultant


Does your medical licensure board protect you? lol no

I was inspired after reading Dr. Jane Orient’s article “Does your medical licensure board protect you?” It was due to this exposure of this article and its embedded video of the Louisiana legislature discussing the proposed bill (SB 286) providing oversight for the LSBME that I first virtually met Senator John Milkovich (the author of the bill) and Dr. Feldman (a doctor abused and punished by this horrific board). Both of these men spoke so passionately, honestly, frustratingly, eye-openingly, and fervently of the scandalous abuses, corruption, and absolute terror the medical board has been infiltrating into the healthcare community for decades. The healthcare industry in Louisiana is the proverbial good ol’ boy system. This here establishment don’t want nobody comin’ on up in here and fixin’ anything. Cuz they don’t think anything is wrong with the way they been doing business for literally centuries. The LSBME looks at anyone who comes from outside the state as a foreigner who wants to change things. Well, yeah, of course we want to improve the system, provide more choices— I think its called progressivism and most states embrace and even encourage it. Nope not Louisiana. Most of the standards of care in the South are notoriously outdated, racist, and inhumane. So if you ain’t one of the good ol’ boys with a name that has a -eaux in it, they will hang you, literally. There are at least six physician suicides attributed to the harassment and investigation done by this board. And although I am still alive, the trauma and emotional abuse of dealing with the LSBME is something to which I can attest. So after stumbling upon this article, I finally felt like there were other humans out there who could understand my sheer and utter frustration and anger at this illegal process. Instantly I was filled with gratitude and hopefulness to have found these doctors and the Senator who are not afraid to call out the injustice happening in Louisiana. I finally felt like possibly with the passage of this bill that there would finally be a platform for others to listen to my story and believe it. The board was finally being called out on their blatant railroading and destroying of people’s lives without fair investigations nor hearings. I am thankful that these individuals have had the guts to stand up to these bullies and speak the truth. I am thankful to be able to sleep more soundly knowing that other people have the sanctity of the healthcare field in their sights since my children still live in Louisiana. Below is Dr. Jane Orient’s article.

https://aapsonline.org/does-license-board-protect/

A bill, SB 286 introduced by Sen. John Milkovich, that would give doctors the right to defend themselves if brought before the state licensure board, the Louisiana State Board of Medical Examiners (LSBME), was heard in the Louisiana state House of Representatives on May 2. If it passes, doctors could find out exactly what they’re accused of, see the evidence, and present a defense to an unbiased judge and jury. They are Americans, right? Even terrorists and rapists have these rights.

In fact, a doctor can be delicensed, bankrupted, disgraced, and made unemployable, based on an anonymous complaint that might have come from a disgruntled employee, a jealous competitor, an insurance company that doesn’t want to pay a bill, or a drug addict who wants a lighter sentence for stealing a prescription pad and forging prescriptions.

A board employee functions as investigator, prosecutor, judge, jury, and executioner. The politically appointed members of the board almost always rubber-stamp what the board staff wants. The staff generally controls the flow of information to board members and accused doctors. The doctor has no right to cross-examine accusers, to ask that conflicted or biased staff be recused, or to challenge the evidence against him—which he might not even have seen.

Don’t believe it? Listen to the testimony on SB286, the Physician’s Bill of Rights. (It starts at 1 hr, 34 minutes into the official video.) You’ll hear about doctors who were tops in their field unable practice their profession anywhere. At least six physicians were driven to suicide. A physician’s disabled employee lost her profession and livelihood when the board forced him to fire her. Families were devastated. Doctors were forced to spend tens of thousands of dollars and months in remote in-patient drug rehabilitation facilities, even though the facilities themselves found that the doctor never had a drug problem.

Most disturbing are the remarks by the opponents of due process rights for physicians, including the Federation of State Medical Boards and Public Citizen, a self-identified consumer advocate group. They did not contradict testimony about abuses. Instead, they asserted that “doctors need to be held to a higher standard” because “patients’ lives are at stake.” There’s an opioid epidemic, and sexual misconduct occurs, and complainants may fear retaliation of some sort if their identity is disclosed. Therefore, we dare not “tie the board’s hands” and impede their ability to “protect the public against bad doctors.” If the board ruins a few good doctors and even drives some to suicide, so what?

Doctors have “enough” rights, it was claimed. The current executive director of the LSBME read aloud from the board’s policy manual. But despite a legislator’s repeated attempt to get a “straight answer” out of him, he would not say whether one of the doctors who testified could finally get a copy of his own complete file, which he had been requesting for years.

The board’s supporters were dismayed at the prospect that a doctor might be able to question an investigator’s objectivity. Witnesses for the bill mentioned, several times, the chief investigator, She-Who-Is-Not-Supposed-to-Be-Named, who was formerly also the executive director. She had dismissed thousands of complaints and had been helpful to some doctors, but had ferociously attacked others, who appeared to be exemplary physicians.

So, who should care about a few doctors who might have been treated unfairly?

Doctors thinking of practicing in Louisiana should watch what happens with this legislation. Young people considering a medical career should be aware that their huge investment of money and years of their life could be wasted at the whim of a powerful official who is immune from any accountability for wrongfully destroyed lives. (The situation is not confined to Louisiana.)

Patients should worry. Thousands of Louisiana patients found themselves suddenly without treatment, and shunned by other doctors who feared being the next pain-management doctor to be cut down. Patients needing an affordable diagnostic test will have fewer choices because an excellent CT scanner and MRI machine were sold to someone in Dubai by a highly competent American doctor delicensed and bankrupted by the LSBME. Sick patients will have to rely more on practitioners with limited training because of the shortage of highly trained, experienced physicians.

All Americans should be alarmed at the burgeoning power of the administrative state, which is exempt from the limits placed on regular civil and criminal courts. If doctors can be stripped of their rights, so can you. Please watch the hearing and see for yourself.

Ahhhhhhh the sisterhood

If its one thing midwives and women in general are not good at, its having each other’s backs and being empathetic and supportive, which is ironic since we are trained to be compassionate, caring professionals whose job title literally means with woman. I have only met a few midwives, who have not been through some sort of legal nightmare, able to have sympathy for those of us who have records so-to-speak. I don’t understand why it is so hard to imagine that at any minute, they could be me and the laws, rules, and decisions affecting my license suspension and denial could affect them. It is a bizarre occurrence that falls somewhere between ignorance, not caring, and denial of reality.

So, since my license in Florida is going nowhere, I email some Florida midwives in peer groups and associations. Recently the midwives in Florida have had to hire lobbyists to help them fight the sunset rule changes instigated by none other than ACOG. I think to myself that perhaps I can utilize these lobbyists, again if only to put political pressure on the Department of Health or maybe they could point me in the direction of some sympathetic legislators or even attorneys they would recommend. Since I only have 21 days to file an appeal, time is of the essence, and I need to decide what I am going to do.

While the Florida midwives I know locally and have worked with have been nothing short of amazingly supportive, concerned, caring, and helpful, I feel some midwives who are more vested in the licensing system could also benefit my cause. So, I send messages to a key player in midwifery politics about my situation. This midwife is also on the administrative staff at one of the Florida midwifery schools, so she knows laws, but more importantly, she is vested in making more midwives. I get a response on 9/7 that lobbyists may not be who I want, but this midwife knows of people on the council staff.

Yeah, that doesn’t help me because you see the Council of midwifery is just a bunch of figureheads. They do cursory things but nothing substantial like have any say in licensure. I explain this to the midwife and again I request the lobbyists contact information just so I can ask them for advice. I am even willing to pay them for their time.

She replies that she will send them my contact info because they are not actually willing to take phone calls from individual midwives.

Uh that is weird, but ok.

She continues stating that the lobbyists are not familiar with licensure pathways at all, but are purely for legislative recommendations and changes.

Ummmmmm, hold up sister midwife. If these lobbyists are designed to watch laws bring pushed through the legislature, shouldn’t they know what the rules are so they can make recommendations to the changes? If that is their job then heck yeah they will understand licensure pathways. But regardless, I have completed ALL the pathways to licensure in Florida and have been denied twice. So, it doesn’t matter which pathway we look at. I have successfully completed both. I actually exceed the education requirements for Florida licensure. Oh, you want a midwife who is a CPM and was licensed in two states? That is me. Oh, you want a midwife who has two degrees in midwifery, one of which is from a Florida school? Yup also me. At this rate, I think it would be easier for me to go to the Bahamas get my medical degree and come back to Florida as an MD.

Back to my communications with my Florida sister midwife… she suggests I listen in on a legislative-focused phone call where afterwards midwives will be able to ask questions.

Uhhhhh, a conference call about legislation is not the appropriate time nor place to discuss my licensing situation.

To be fair, my sister midwife is very kind and offers to give me contact info for the Department of Health’s key figures in licensing midwives, but she misses the mark in truly helping me at all other than providing lip service.

Again, I am not reaching out to my sisterhood for names and numbers I already have. The normal mechanism for licensure is broken in my case and I need to go to plan B or C or D at this point. A week later, I reach out to her again and ask if the lobbyists have received my info. I am a little miffed with this association. Again, I am on a strict timeline.

She indicated that the lobbyists felt they couldn’t really help me and again referred me again to the DOH who started the whole denial process.

Circles, circles I tell you. I do not understand why the Florida Association of Midwives has lobbyists that will not even consult the people who pay their salaries. And for someone whose job is working at a midwifery school, I really hope this sister midwife helps her students navigate the licensing nightmare more than she has helped me. Am I surprised that I cannot get more assistance from the groups spear-heading midwifery in Florida. 

Don’t take it personally, I remind myself.  Time to go read the four agreements again. Sigh.